APPLICANT INFORMATION:

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1. Are you a FAFCU Member? (Required.)

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2. Applicant's Name (Required.)

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3. Phone Number (Required.)

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4. Address (Required.)

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5. Social Security Number (Required.)

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6. Date of Birth (Required.)

Date
SCHOOL INFORMATION:

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7. High School Information (Required.)

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8. College or University Information (Required.)

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9. Have you been accepted? (Required.)

PARENT/GUARDIAN INFORMATION:

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10. Relationship to Applicant (Required.)

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11. Are you a FAFCU Member? (Required.)

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12. Parent/Guardian's Name (Required.)

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13. Phone Number (Required.)

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15. Address (Required.)

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16. Social Security Number (Required.)

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17. Date of Birth (Required.)

Date

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18. Employer Name (Required.)

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19. Employer Address (Required.)

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20. Employer Phone Number (Required.)

PARENT/GUARDIAN FINANCIAL INFORMATION:

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21. Adjusted Gross Income (Form 1040) (Required.)

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22. Total Federal Tax (Form 1040) (Required.)

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23. Total Income of Father/Guardian (Required.)

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24. Total Income of Mother/Guardian (Required.)

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25. Yearly Untaxed Income Benefits (Social Security, AFDC, Child Support, Other) (Required.)

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26. Total Cash, Checking, Savings, and cash value of Stocks (exclude retirement plan funds, IRA, 401(k); include educational IRAs and 529s) (Required.)

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27. Medical and Dental Expenses not paid by insurance (exclude premiums) (Required.)

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28. Marital Status (Required.)

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29. Total number of family members living in the household and primarily supported by the reported income (Required.)

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30. Total number of family members attending college at least half-time during the next school year, including applicant (Required.)

DOCUMENTATION:

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31. Personal Statement, Transcript, & Letter of Recommendation (Required.)

CERTIFICATION & AUTHORIZATION:

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32. I certify that the information in this application is accurate to the best of my knowledge. I certify that I am a senior in high school enrolled or applying for full-time enrollment to a college or university for the 2024-2025 academic year. If requested, I agree to provide proof of information I have given, including a copy of my U.S. Income Tax Return. I authorize First Atlantic to utilize information about my application and my personal statement for publicity and public relations purposes. (Required.)

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33. Applicant Signature (by typing your name you agree to the above) (Required.)

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34. Date (Applicant) (Required.)

Date

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35. Parent/Guardian Signature (by typing your name you agree to the above) (Required.)

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36. Date (Parent/Guardian) (Required.)

Date
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